Processing insurance claims is a significant part of the business activities of insurance companies. Efficient processing of insurance claims provides benefits not only in retaining and attracting customers, but also in minimizing costs. In the past, insurance companies have serviced insurance claims the same, regardless of complexity. Recently, however, there has been more focus on handling insurance claims differently based on the complexity of the individual insurance claim.
In general, insurance claims may be grouped into three segments, namely, 1) Core Claims; 2) Express Claims; and 3) Fast Track Claims. Core Claims may include low frequency, higher relative severity claims that are typically handled by a human expert claim handler. An example Core Claim may be a large commercial liability insurance claim with multiple claimants.
Express Claims may include high frequency relatively low severity claims that require human handling, such as insurance claims related to vehicle damage, or personal property loss. Fast Track Claims may include insurance claims of relatively low severity that can be handled without human intervention, such as an insurance claim related to only broken automobile glass or a claim related to a relatively minor theft/vandalism incident. With Fast Track Claims, a basic task, such as matching the loss to the policy of the insured or issuing a payment in response to receipt of an invoice, may be automated to be performed automatically.
However, due to the complexities and multiple separate tasks that are associated with most insurance claims, relatively few insurance claims may be categorized as Fast Track Claims. In addition, insurance claims categorized as Express Claims are still handled by a human, who performs each task manually, regardless of complexity. Accordingly, to maximize efficiency what is needed is a system that can separate an insurance claim into individual tasks, identify those individual tasks that are capable of being completed in an automated fashion versus those tasks that need a human claim adjuster. Further, what is needed is a system capable of automated completion of more complex tasks by taking into account other aspects of the insurance claim that are not necessarily part of an individual task being automatically completed.